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Background RSV is the leading cause of hospitalization for bronchiolitis in infants and young children worldwide. Second-hand smoke (SHS) exposure has been associated with increased morbidity in children with respiratory infections. The objectives of this study were to explore the association between SHS measured by hair nicotine and disease severity in infants with RSV infection, and to define its impact on the blood transcriptional immune profiles. Methods Single-center, prospective study of previously healthy infants presenting to the Emergency Department with RSV bronchiolitis with and without SHS exposure assessed by hair nicotine levels. Exclusion criteria included: prematurity; chronic medical conditions, and insufficient hair. Clinical outcomes were assessed using a clinical disease severity score (CDSS; ranging from 0 to 15) and care provided (hospitalization and intensive care). Blood samples from patients and healthy controls were obtained at enrollment for gene expression profiling, and differences in profiles stratified by SHS exposure. Results A total of 70 infants with RSV were enrolled (median age 2.7 months; 44 (62.8%) males; 44 (62.8%) white). Hair nicotine was detected in 45 (64.2%) infants with RSV while 25 RSV+ infants had undetectable hair nicotine levels. Demographic variables were not significantly different between SHS exposed and nonexposed infants. Median nicotine concentrations in infants with severe (CDSS >10) vs. mild RSV disease (CDSS < 5) were 5.3 and 2.1ng/mg (P = 0.49). In addition, blood transcriptional profiles in RSV infants exposed to SHS vs. nonexposed, were characterized by significantly greater overexpression of genes related to inflammation, apoptosis and cell death, and greater suppression of T and B cell-related genes (Figure 1). Conclusion In otherwise healthy infants with RSV infection exposure to SHS was associated with greater inflammation and blunted T and B cell responses. Although not statistically significant, hair nicotine levels were higher in patients with more severe RSV bronchiolitis. Disclosures O. Ramilo, Abbvie: Board Member, Consulting fee; Regeneron: Board Member, Consulting fee; Janssen: Board Member and Investigator, Consulting fee and Research grant; NIH: Grant Investigator, Research grant; A. Mejias, Janssen: Investigator and Scientific Advisor, Consulting fee and Research support; Abbvie: Consultant and Scientific Advisor, Speaker honorarium; Novartis: CME lecture, Speaker honorarium; NIH: Investigator, Research grant

Respiratory Syncytial Virus bronchiolitis: Impact of second-hand smoke exposure on immune profiles